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Right hemispheric deep AVM

This 8 year old female patient presented with progressive left hemiparesis and was diagnosed to have a large deep right hemispheric vascular lesion by an initial CT examination.
A combined MRI-MRA study was performed before therapeutic decision making.

Right hemispheric deep AVM, 1.5 T
Fig.1 Sagittal T1-weighted spin-echo images. Abnormal vascular network is seen in the basal ganglia of the right cerebral hemisphere. The presence of a dilated internal cerebral vein (blue arrow) suggests a high-flow lesion (AVM) and rules out the possibility of Moyamoya disease, for example.
Fig.2 Transverse T1-weighted spin-echo images. The honeycomb appearance of the lesion, involving the deep right hemispheric structures, is well appreciated on these images.
Fig.3 Coronal proton-density weighted fast spin-echo images. Multiple perforating feeders and dilated deep midline draining veins are suggested.
Fig.4 Coronal T2-weighted fast spin-echo images. A small increased signal intensity area is seen in the centrum semiovale (arrow) in proximity to the AVM. Otherwise same observations as on Fig.3.
Fig.5 Transverse single slice survey 2D PC MR angiogram (Venc: 60 cm/s, Tac: 36 sec). Rapid confirmation of a high-flow deep abnormal vascular lesion in the right hemisphere.
Fig.6 Transverse averaged modulus (above) and corresponding magnitude of complex differences (below) type source images from a 3D PC MRA acquisition. The multiple punctate vascular structures involving the basal ganglia and the deep cerebral white matter are well demonstrated. Note that the dilated deep midline draining vein remains signal void on the anatomical image (above right) but exhibits intense signal on the flow image (below right).
Fig.7 Transverse targeted MIP reconstruction from the 3D PC MRA acquisition data set. The arterial feeders are not identified on this image, however at least three draining veins are clearly visible, all leading towards the deep midline venous system.
Fig.8 DSA images (A-P and lateral views) showing the deep hemispheric AVM fed by the anterior perforators and drained through the deep midline venous system.

 

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Fig. 1

Right hemispheric deep AVM, Fig. 1
Right hemispheric deep AVM, Fig. 2
Right hemispheric deep AVM, Fig. 3
Right hemispheric deep AVM, Fig. 4
Right hemispheric deep AVM, Fig. 5
Right hemispheric deep AVM, Fig. 6
Right hemispheric deep AVM, Fig. 7
Right hemispheric deep AVM, Fig. 8